![• Urine
- Water (95°
/o) &Solids (5°
/o)]
- Urinary out put: 1-1.5 L per day.
- Almost all substances found in urine are also find in
blood.
- may also contain cells, casts, crystals, mucus &
bacteria.](data:image/gif;base64,R0lGODlhAQABAIAAAAAAAP///yH5BAEAAAAALAAAAAABAAEAAAIBRAA7)
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- 2. • Urine - Water (95° /o) &Solids (5° /o)] - Urinary out put: 1-1.5 L per day. - Almost all substances found in urine are also find in blood. - may also contain cells, casts, crystals, mucus & bacteria.
- 3. • Urine: - Provides information about functioning & abnormalities of kidneys &urinary tract - Help in diagnosis of various systemic diseases [+nee or - nee of several substances in urine]
- 4. Normal constituents of urine Creatinine UricAcid Urea ca++ PO4 3- K+ 0.8 - 1.8 gm/L 0.5 gm/L 25-30 gm/L 0.2 gM/L 1.7gm/L 1.7 gm/L 3.5 gm/L 6-16 gm/L Na+ c1-
- 5. • Preservation - For routine analysis, urine is best examined fresh. - Bacterial growth will ruin a specimen if analysis is delayed for >3 hrs. - Refrigeration: best way to preserve if analysis is delayed. • Refrigeration for >24hrs isn't recommended.
- 6. • Chemicals used - Toluene - Thymol [for sugar estimation] - Formalin - Boric acid - Camphor - Toluol [for acetone estimation] - Chloroform
- 7. Changes occur in non preserved specimen Urea ---+ NH3 t Glucose t KB d/t bacterial utilization - - d/t volatilization - - - 1bilirubin d/t exposure to light - - - - - - - - - - i bacterial number j turbidity bacteria & amorphous Disintegration of RBCs casts j nitrite Changes in color d/t bacterial reduction of nitrate d/t oxidation or reduction of metabolite
- 8. URINE ANALYSIS • Physical • Chemical • Microscopic
- 9. MACROSCOPIC EXAMINATION OF URINE •• •• •• •• •• •• •• •• •• •• •• •• Color Clarity Odor Volume Specific gravity pH
- 10. Color: • Normal urine is of amber color due to +nee of urochrome (urobillin &urobilinogen) in urine. • Colourless: Dilute urine • Dark: Concentrated urine. Colorless - YHigh fluid intake y L Jse of diuretic YDM YDI YAlcohol Dark - Y ow fluid intake YExcessive sweating YDehydration (burns, fever)
- 11. Abnormal colour of urine Cloudy Excess P04, Urates, Pus cells, Bacterial contamination Red Frank Hematuria, hemoglobinuria, Myoglobinuria, Intake of Pyridium, Phenolphthalein Ingestion of Beet root, Black berries Deep yellow Greenish Obstructive Jaundice, Ingestion of Vitamin B complex Obst. Jaundice [excess Billirubin or billiverdin] Phenol poisoning Blue Brown black Methylene Blue poisoning Hemorrhage in bleeding, Acidic urine, Porphyria Black Milky Cola Alkaptonuria +nee of Chyle Nephritic syndrome
- 12. Clarity (Transparency) • Normal urine clear or transparent • Any turbidity will indicate +nee of either of the following: • WBCs (pus). • RBCs • Epithelial cells • Bacteria • Casts • Crystals • Lymph • Semen • Phosphate
- 13. ODOR Ketoacidosis Phenylketonurea Normal fresh urine - - Standing for long time Bacterial action of pus (UTI) Faint aromatic odor Ammoniac odor d/t +nee of volatile acids Offensive odor - - Fruity odor Mousy odor - - - - r
- 14. VOLUME Oligouria Polyuria Anuria Nocturia - - j urination during night l] t in urine flow - j in urine flow - [< 400 m - - - [> 2500 ml] <100ml/day 600 - 2500 ml /24hr 0.5-1ml /kg/hr Children 200-400ml/24hr 4ml/kg/ hr
- 15. • Causes of anuria: • Severe Renal Defect • Loss of urine formation mechanism. • Due to +nee of stone or tumor. • Post transfusion hemolytic reaction. • Incompatibility between donor's &receiver's blood hemolysis excess Hb causes renal tubules acute renal failure. blockage of
- 16. Causes of polyuria: Causes of Oliguria: jed fluid intake- - jed salt & protein intake Addison's disease Intravenous saline or glucose Chronic glomerulonephri tis Diuretics intake Psychogenic polydip -sia - - DM DI Water deprivation Dehydration - - Prolonged vomiting Diarrohea Excessive sweating Acute renal failure Renal lschem ia Obstruction [Calculi,Tumor, Prostatic hypertrophy]
- 17. • pH One of imp. functions of kidney is pH regulation. Blood pH: 7.4 &urine pH: - 6.0 (4.6 - 8.0) [due to secretion of H+ &reabsorption of HC03-] Urine pH 9, indicate that urine is stand for a long time &must be rejected. Acidic urine - Alkaline urine Acidosis Alkalosis UTI [Proteus] OKA Starvation Dehydration - - RT A Vegetarian diet - - Diarrhea E. coli infection Muscular fatigue
- 18. Clinical significance of pH 1. Determine existence of acid base disorder. 2. Precipitation of crystals to from stone requires specific pH for each type. • Hence, pH control may inhibit formation of these stones. Crystals in acidic urine Crystals in alkaline urine Ca oxalate Ca carbonate - - Uric acid Ca phosphate Mg Phosphate - -
- 19. Specific gravity • Normal: 1.015-1.025. • Theoretical extremes: 1.003 to 1.032. • Contamination during collection &storage gives false value. Sp. gravity is jed in •DM [Glycosuria] _ _ _ _ ... •Nephrosis [Albuminuria] •All cases of oliguria - - - - - - ' •Hematuria •Hemoglobinuria Sp. gravity is t ed in •Excessive water intake •DI •Chronic glomerulonephritis •All cases of polyuria [except DM] •Execessive sweating
- 20. • Low fixed specific gravity - Due to loss of concentrating ability by damaged tubule, sp. gravity of urine is fixed at 1.010. - Found in: • Chronic glomerulonephritis-end stage kidney • ADH def. • Polycystic kidney • Chronic pyelonephritis
- 21. • Chemical examination of Urine Sugar Protein KB Hb Blood Mucin Bile salt Bile pigment Porphyrin 5-HIAA
- 22. • Urine examination for +nee of Sugar - Glycosuria is defined as presence of sugar in urine in a amount that can be detected by chemical methods. - Reducing subst. found in urine: Sugar Non-sugar Glucose [DM, Endocrine disorder] Lactose [Pregnancy, Lactation] CHCl3, Formaldehyde [preservative] Homogentistic acid Fructose Ascorbic acid
- 23. Hyperglycemic glycosuria • Blood glucose > Renal threshold for glucose glycosuria • Occurs in Endocrinal disorder » DM » Cushing's syndrome » Hyperpituitarism » Hyperadrenalism
- 24. • Alimentary Glycosuria High glucose intake at once for > 1 week ! t ed tolerance of body for glucose ! Glycosuria
- 25. Renal glycosuria Defect in renal tubule ! Subsequent lowered renal threshold for glucose ! Glycosuria • Occurs in: - RT A - Heavy metal poisoning - Fanconi's Syndrome
- 26. Benedict's Test • General test for Reducing sugars • Reagent's composition: 26 CuS04 17.3gm Na2C03 1OOgm Provide alkaline medium Na-Citrate Dist. water 173gm 1OOO ml Cu++ chelating agent [slowly releases Cu++ ]
- 27. Benedict's Test • Copper reduction test in alkaline medium • Principle: - Reducing sugars under alkaline medium, tautomerise to form enediols (powerful reducing agent), which reduces cu++ to cu+. CuS04 Cu++ + SQ4-- Cu++ + Na-citrate Reducing sugar Enediol + Cu++ Cu-Na-citrate complex Enediol Cu+ + sugar acids Cu+ + OH- 2 CuOH CuOH Cu20 ( !) 27
- 28. • Procedure - 5 ml of Benedict's reagent was taken in a test tube. - 8 drops of urine was added. - Mixed well. - Boiled for 2 min - Cooled &color was observed. Observation Inference Sample B
- 29. Benedict's Test Yellow to red PPT +++ 1.5-2.0 gm0 /o Brick Red PPT ++++ >2.0 gm0 /o • Final color formed is dependent on amount of reducing sugars +nt in given sample, thus benedict's test is known as Semi-quantitative test. 29 Blue color -ve Green colour Trace < 0.5gm0 /o Green PPT + 0.5-1.0 gm0 /o Green to yellow PPT ++ 1.0 - 1.5 gm0 /o
- 30. KETONURIA • Usually found ketone bodies in human body &urine are: -Hydroxy butyrate --Acetoacetate------ Acetone [Primary] • Normal level of ketone bodies in blood: 70mg/dl • Renal threshold for ketone bodies: 1mg/di • normallly excreted in urine. [<20mg/day] jed KB in urine Intake of high fat & low carbohydrate diet Starvation Uncontrolled DM Prolonged vomiting